A Complete Guide to Shoulder Arthritis

The shoulder is often called as the most movable joint in the entire body. This is because of the instrumental role it plays in most daily activities. This daily wear and tear can lead to shoulder injuries. Repetitive shoulder injuries, such as dislocations, often predispose to shoulder arthritis.

What is shoulder arthritis?

It is the degrading of the articular hyaline cartilage that lines the glenoid cavity and the ball of the humerus. The hyaline cartilage present allows smooth movement of the shoulder joint, so degradation of it leads to a loss in motion.

There are three main forms that you should be aware of:

1. Osteoarthritis: This form is mostly found in the elderly and athletes. It is the wearing down of arthritis that can be caused by aging or excessive, vigorous use of the shoulder joint.
2. Post traumatic Arthritis: This form occurs when the cartilage is destroyed as a result of trauma. This usually happens as a result of severe accidents, fractures and dislocations.
3. Rheumatoid Arthritis: This form occurs due to autoimmune disease where the body attacks its own cartilage through immune complexes and factors. It is due to a combination of genetic and environmental factors. It’s interesting to know that this often affects both shoulders at the same time.

What are the signs and symptoms?

• The first sign is difficulty in shoulder rotation such that it prevents the arm from reaching the back. This means being unable to scratch your own back.
• There are intermittent flare ups of pain. This happens due to the grinding of bones and often presents at the front of the shoulder. The pain gets worse with motion
• Slow and subtle loss of motion over time. This is often painless
• Weakness and stiffness over the years
• Inability to sleep on the side of the affected shoulder.

How can it be diagnosed?

It can be diagnosed by X-rays and MRIs, which can help visualize the abnormal increase in space in the joint cavity. This can also give information about the degree and severity of shoulder arthritis. MRIs can also show soft tissue damage, such as thickened biceps tendons, that are often common with this disorder.

What are the available treatments?

The initial flare ups of pain can be treated with over the counter pain medicines and anti-inflammatory medicines. As the pain increases and can no longer be managed with medicines, other measures are necessary, which are detailed below.

A visit to a physical therapist is necessary. They can devise a home-based work out plan that includes a range of motion exercises that will help in keeping the shoulder mobile. This can be done by incorporating stretching and strengthening exercises. Stretching exercises are a vital part of the treatment regimen as they help prevent stiffness of the shoulder. It is the stiffness that leads to a decrease in shoulder motion, by preventing stiffness, one can slow down the loss of movement. Strengthening exercises that focus on providing more stability to the muscles of the shoulder and rotator cuff muscles are important as they help minimize pain flare ups. They also help maintain upper extremity function.

Other unconventional methods of physical activity such as yoga, tai chi, and Pilates have also been reported by patients to be useful in helping them deal with their arthritis. Another method that has been reported to help with pain flare ups is cryotherapy. This is when the sensation of cold is used to manage inflammation. For shoulder arthritis, this can be in the form of an arm sling that applies cold water to the shoulder and a pump that can be used to move the water around. This can be done 20-30 minutes at a time.

How will you know the arthritis has progressed?

Shoulder arthritis is in its mild form when there is pain and slight difficulty in movements. It progresses to a more severe form when the rotation of the arm at the waist produces sounds. These sounds can be crunching and clucking sounds, and squeaking sounds at the shoulder.

What to do when the arthritis progresses?

The progression of arthritis does not necessarily entail surgery. It can however lead to greater pain that can no longer be treated with anti-inflammatory medicines. In this case, a more direct approach with pain alleviating injections need taken. These injections can be corticosteroid injections; this provides immediate relief from pain. The other injection can be a synthetic hyaluronic acid injection which though helpful, does not offer complete relief from pain.

When does surgery come into play?

When no other form of pain management seems to work, surgery is important for the health of the patient. The pain can often be excruciating and lead to mental distress. It also prevents the patient from performing simple daily activities such as bathing and clothing themselves.

Arthroscopic Debridement Surgery: It is a minimally invasive form of surgery. It is less traumatic than surgeries where the joint is fully exposed. It is also better as the recovery time is shortened due to decreased damage to connective tissue.

‘Debridement’ means cleaning up of any unwanted material that can otherwise obstruct the joint cavity and lead to pain. In arthroscopic surgery, floating pieces of bone and cartilage in the joint cavity is removed. Any degenerated soft tissue around the joints is also removed. This may include biceps tendons which often become torn and thickened after undergoing arthritic changes. This can result in pain.

Though rare, arthroscopic surgery can have severe adverse effects including venous thromboembolism, infections and nerve damage.

Shoulder replacement: In this surgery, the glenoid cavity is often capped while the upper end of the humerus is replaced with an artificial ball. While not as common as knee or hip replacement surgery, these surgeries are now increasing due to it providing complete relief from arthritic pain. Patients can often go home after one night of monitoring at the hospital and after the healing of the incision there is no other pain.